Provider Demographics
NPI:1831651371
Name:RICHMOND, ZACHARY L (MMFT, LPC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:L
Last Name:RICHMOND
Suffix:
Gender:M
Credentials:MMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 W SOUTHLAKE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7031
Mailing Address - Country:US
Mailing Address - Phone:817-488-0502
Mailing Address - Fax:817-488-0495
Practice Address - Street 1:191 W SOUTHLAKE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7031
Practice Address - Country:US
Practice Address - Phone:817-488-0502
Practice Address - Fax:817-488-0495
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81839101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor